It is important to note that if there is significant MAC, an Alfieri Stitch, no matter where it is placed, will NOT resolve the MR.
Another maneuver that I have found to be helpful if the P2 segment is not well visualized is inserting a scope into the LV, via the aorta. It is imperative to identify exactly where the P2 segment is located to obtain adequate approximation. The A2 segment is relatively easy to find. Remember to stay 1/2 cm from the free edge.
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